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631-244-0300
info@pojerofamilychiropractic.com
Home
Services
Adult Chiropractic Care
Kids Chiropractic Care
About Us
Dr. John & Dr. Gaby
Testimonials
Gallery
Subluxation
Subluxation
Spinal Degeneration
Forms
Welcome Form
Patient Consent Form
Personal Health History Form
Child Health History Form
No Fault Form
Terms Of Acceptance Form
HIPAA Form
Contact Us
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Welcome to Pojero Family Chiropractic
We would like to extend a warm and personal welcome to you. Excellent and quality chiropractic care is our trademark. You will be offered many informative and entertaining educational opportunities while at this office. Let’s begin this health process with some basic information. Please read and complete the following forms and return them to the front desk. Thank you for giving us the opportunity to serve you.
Mission Statement
We at Pojero Family Chiropractic are committed to serving the true health care needs of as many people as possible that are within our reach. We acknowledge the devastating effects of the vertebral subluxation on human health and therefore go to extraordinary measures in educating our communities about the benefits of chiropractic for the restoration and maintenance of health. Our mission is to serve as many people as possible with the highest quality chiropractic care so that these masses may realize their full human potential. We encourage our patients to help us by participating in this most important and noble mission.
Purpose of this Office
To create a healthy environment that instills responsibility, trust, honesty, and love among everyone. Your attitude about your health is important to us as the specific reason you've consulted our office. Below are four prevalent health attitudes.
Name
*
First
Last
Please select the one that most closely reflects your personal values
Treatment Only. I only consult a doctor when I have an ache or a pain and discontinue care as soon as it has cleared up.
Prevention. In addition to symptomatic treatment, I consult specialists occasionally to prevent problems from recurring.
Maintaining Health. I’m conscious about my health, diet, exercise, etc. And actively pursue these because I feel better, perform better, and it maximizes my potential.
Family Health. I take an active part in assisting, informing, and maintaining health, with my family. I’m concerned with the long-term effects of good health.
Thank you
We look forward to a healthy relationship with you!
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Pojero Family Chiropractic
153 Main Street, Sayville, NY 11782
631-244-0300
info@PojeroFamilyChiropractic.com
www.PojeroFamilyChiropractic.com
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